Radically open dialectical behaviour therapy

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Radically-open DBT (RO-DBT) is a complex psychotherapy crafted to assist individuals displaying overcontrolled tendencies in moving toward their valued goals, particularly in a social context (Lynch, 2018). It is individualized and involves both individual sessions and classes on RO-DBT skills. These skills are not typical social skills but rather strategies to encourage openness, flexibility, and social connection. Individual sessions focus on identifying valued goals as well as understanding one's social signals and how these align with those goals.

RO-DBT has been heralded as an effective treatment for individuals whose depression or anxiety has not responded to other therapies.

Within RO-DBT, all individuals are seen as falling somewhere on the dialectic between undercontrolled and overcontrolled. Under-controlled individuals tend to be more impulsive, have strong expressed emotions, and may be more prone to addiction. On the contrary, over-controlled individuals tend to be less expressive, more withdrawn, and driven by more rule-governed thinking. Everyone falls somewhere on the continuum and being "undercontrolled" or "overcontrolled" is not necessarily a problem.

While overcontrol itself is not a diagnosis, when these traits begin to block a person from their valued goals, RO-DBT can help. While not every autistic person is overcontrolled, there is a tendency toward the overcontrolled pole in individuals with this diagnosis. As such, RO-DBT has been studied in autism.

Initial results have been positive, showing that across diagnostic categories, autistic people who had another mental health diagnosis reported less distress after RO-DBT, even more so than neurotypical peers (Cornwall et al., 2021). The goal is not to turn an overcontrolled person into an undercontrolled person or to change a personality, but to help an overcontrolled person cultivate what's important to them.

Masking or Adaptive Social Signaling
Within traditional social skills training, there has been a tendency to simply teach a neurodivergent person to act more like a neurotypical person. One could ask whether the use of RO-DBT may be doing the same; in other words, encouraging a person to mask traits that might be core to their self. To the contrary, RO-DBT is highly individualized. What one person identifies as an adaptive social signal that they would like to grow, another person may identify as a problematic social signal that they wish to change. Identification of treatment targets is done as a collaborative process between the individual and therapist. These targets are also discussed and evaluated at each session through an instrument known as a diary card.

When done well, RO-DBT would be expected to encourage open expression rather than masking. Unlike longstanding behavioral interventions for autism and related diagnoses such as applied behavior analysis (ABA), RO-DBT's success rests on the alliance between the therapist and the individual walking in the direction of their valued goals. The use of RO-DBT skills is contextual and tends to link back to those valued goals. In addition, a process known as self-enquiry is utilized within RO-DBT to assist with self-exploration. The spirit of self-enquiry is not to find an answer but to find more questions. This is somewhat different from Socratic questioning, often used in cognitive behavioral therapy, in which there could be some aspect of the therapist guiding the individual to a particular discovery.

Only time and research will tell how effective radically-open DBT is in meeting the needs of neurodivergent people struggling with emotional distress. Initial findings are encouraging. There is a huge need in this area.